When it comes to exercising with a disability, what is more important, endurance or strength training? The short answer is: both. Strengthening refers to increasing muscular power and mass, which also improves the body’s metabolism. We need strength to perform our daily activities.

Improving strength requires muscles to be put under more challenge than they are accustomed to, which will stimulate protein growth within cells. This is done in shorter bouts of exercise with weights, and recovery is important. A day of rest after a day of strengthening exercise will help the muscles increase mass.

Endurance training, also called cardiovascular exercise, refers to using several groups of muscles to increase the heart rate for a prolonged period. Good examples are pushing your wheelchair, cycling, playing sports, etc. These exercises promote oxygen delivery to the body, which keeps the muscles, nerves and brain healthy. They also improve heart and lung function.

Both Are Best

The answer to which form of exercise is more important is that both are important for your health.

Strengthening exercises help maintain as much independence as possible. Weakness can impact the ability to transfer from a wheelchair or do basic activities independently. Strength training is also a way to maintain your weight, as added pounds can certainly impact mobility. The more muscle mass you have, the higher your metabolism. It is easier to maintain your weight if you have more lean body mass. Strengthening the muscles of the rotator cuff decreases overuse injuries of the shoulder; and strengthening core muscles decreases back pain — both are common among people who rely on wheelchairs. Performing this type of exercise three times per week is recommended.

Cardiovascular exercise is important to decrease the risk of or manage health complications such as hypertension or diabetes, which can lead to strokes or heart attacks if not controlled. This exercise keeps your heart healthy, and your brain healthy! Aerobic exercise decreases the risk for dementia and neurodegenerative diseases. The American Heart Association recommends 30 minutes of endurance training, six days per week.

The Right Effort

Now you know that you need to do both strengthening workouts and aerobic workouts, but how do you know which one you are doing?

One way to monitor if you’re in the “strengthening zone” versus the “endurance zone” is monitoring your heart rate. You can manually take your pulse or purchase a heart rate monitor to wear on your wrist.

Calculate your maximum heart rate by subtracting your age from 220. For example, if you’re 50 years old, subtract 50 from 220 for a maximum heart rate of 170 beats per minute (bpm). The strengthening zone is 80–90% of your maximum heart rate range, so a 50-year-old’s heart rate should be in the 136–153 bpm range. The endurance training zone should be 65–75% of your maximum heart rate, so 111–128 bpm for a 50-year-old.

Several factors can affect the heart rate’s response to exercise. Medications can increase your resting heart rate or decrease the amount the heart rate can increase from resting. If you have an injury that affects your autonomic system (this can be true for spinal-cord injuries above T-4, multiple sclerosis or stroke), the heart rate may not be a reliable vital sign for effort you’re putting in.

Another way to monitor your effort level is using the rate of perceived exertion. This is a 1–10 scale for how hard you’re working, with 1 being “not at all,” and 10 being an “all-out effort” that can’t be sustained for very long. See a visual scale for the rate of perceived exertion above.

If you’re working on your triceps, you want that muscle to feel like it’s reaching the 8–9 level. You may not be out of breath, but the muscle is unable to keep working. For cardiovascular training, you want to be in the 5–7 range. You feel like you’re putting forth effort, but it can be sustained. You may feel out of breath, but could carry on a conversation.

Exercise – It’s All About Intensity

We talked about the importance of getting exercise – both strengthening and aerobic. But are you sure you are exercising? Exercise decreases the risk of complications associated with disability, such as heart disease, diabetes, respiratory infections, urinary tract infections (UTI), pressure sores, and even certain forms of cancer.

The definition of exercise is “physical activity that is planned, structured and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation.” The reason this is important is because exercise goes above and beyond your daily activities. Doing housework or yard work is physical activity, but it’s not exercise. And the difference can often be clarified by considering the intensity at which you feel like you’re working. Remember that exercise is stress on the body, and if you aren’t feeling that stress, you’re probably not exercising.

Let’s take another look at that Rate of Perceived Exertion scale. 1 is resting, probably how you feel now. 10 is that all out sprinting effort that can’t be sustained for very long. For your aerobic exercise, you want to workout in the 4-6 range. It should feel effortful, and you may be short of breath, but could still have a conversation. If you’re not getting tired by the exercise, it probably is in that 2-3 range. Housework and yard work is in this 2-3 range. Think about this scale the next time you’re exercising – and if you are not reaching that 4-6 level, think about how to get up there safely.

Your level of effort is unique to you. Your 5 may be different than your spouse’s 5 or your friend’s 5.

As your fitness improves, it’ll take more work to get to the same intensity. That’s great! It means you’re getting stronger and reaping the benefits of your work. But it also means you can’t get complacent with your exercise routine, and you’ll need to step it up.

When I ask people what their exercise routines consist of, I often hear that they push their chair, or walking, which is great. But I follow up by asking “are you working at an intensity that constitutes exercise?” If not, that needs to be a new goal. Exercise is also done above and beyond any physical therapy you may be getting.

Consider exercises that use different muscles than the ones you’re using all day to push your chair and transfer. This can exacerbate shoulder pain. Think about exercise that use more of the muscles in the back of your shoulders and include pulling rather than pushing. Trying different sports is a great way to push the intensity.

Author: Kristin Mcnealus

Author: Kristin McNealus, DPT, MBA
I am a physical therapist, and enjoy endurance sports. I used my passion for exercise and knowledge of what the body is capable of performing to launch Every Body Fitness, an online exercise platform for every body to be able to reach their fitness goals. www.ebfitnessonline.com

As a person with a disability involved with adapted sports, weight training and intensity are very important for me to develop and maintain strength. It also helps me with developing quick muscle repetitions. Thanks for the tips.

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NCHPAD promotes increased participation in physical activity among people of all abilities. This blog, is a site where readers and contributors can share information and generate new ideas.